T Nation

High T Despite Very Low Dose Androgel

A PCP can order an MRI of the pituitary. Blurred vision can be one of the signs of a pituitary adenoma. If you have a tumor and it’s large enough it can press on the optic nerve which lies just above the pituitary. Given your labs that, as others have said, don’t seem to make sense because you’ve been on TRT it would be easy for your PCP to justify the MRI. Other labs I would suggest so you have numbers to start with from here are prolactin and 8am corisol. Have you had a testicular exam done? You might also want to ask for Alpha-Fetoprotein marker and B-HCG blood tests as well to rule out testicular cancer.

[quote]Squiggie wrote:
A PCP can order an MRI of the pituitary. Blurred vision can be one of the signs of a pituitary adenoma. If you have a tumor and it’s large enough it can press on the optic nerve which lies just above the pituitary. Given your labs that, as others have said, don’t seem to make sense because you’ve been on TRT it would be easy for your PCP to justify the MRI. Other labs I would suggest so you have numbers to start with from here are prolactin and 8am corisol. Have you had a testicular exam done? You might also want to ask for Alpha-Fetoprotein marker and B-HCG blood tests as well to rule out testicular cancer. [/quote]

PCP would not order the MRI. He was completely useless and told me to ask my other endo or see a different one. Anyway, I am seeing a new endo next week, and will still contact my current endo to request the MRI.

I agree about checking Cortisol, perhaps also HGH, and ATCH. Prolactin was normal when checked within the last couple months. Testicles were also examined recently and everything seemed OK. Regarding the blurred vision, that hasn’t happened at all recently. I think at this point the MRI is just to rule out the worst case scenario, but I will still attempt to get it.

[quote]StevieA wrote:
Concerning your high levels of T while on a low dose of transdermal, I’ve had the same result. I’ve been on Testim 1%, 50mg daily for about 8 years and my TT levels have consistently been between 800 and 1345 (Quest, 241-827mg/dl). I conclude, from all the info I’ve gotten here, that we are simply good absorbers. My most recent lab uses different ranges for T so I don’t yet know about those, but my lab from 11/2011 has TT at 1335 (241-827 mg/dL). I know this isn’t of any help with your other issues but just wanted to let you know I’ve had similar results from transdermal T. Good luck![/quote]

Good to know! The abnormal response to the low dose is definitely part of the puzzle.

[quote]jimbo12 wrote:
Have you had a testicular exam done? You might also want to ask for Alpha-Fetoprotein marker and B-HCG blood tests as well to rule out testicular cancer. [/quote]

Just as an aside, these blood markers can be hit or miss as far as usefulness for TC. When I had TC, these two and LDH (which is the 3rd marker) were all within range and didn’t show any sings of TC. Self-exam is the best practice, and following up with uro for an in-person diagnosis.

Still working on getting an MRI, but I thought I’d update with more recent labs. Not sure if this warrants any new discussion… anyway, DHT came out high, as I expected. T also came out higher this time leading me to believe I am indeed absorbing the Androgel. This T reading is more consistent with past readings throughout the past two years.

LH and FSH still very high, and consistent with last set of labs. E2 still low end of normal. Now WBC coming out a little lower. A few new tests done such as PSA, cortisol AM, TSH, and IGF-1. All are within range and not raising huge red flags about pituitary, but I am still going to request the MRI.

DHT 139 ng/dl (high), reference range is 30-85
T 1295 ng/dl (high), 348-1197
Free T was 34.32 mg/dl (high), 5-21
% Free T was 2.65 (normal), 1.5-4.2

LH 20.7 mIU/mL (high), 1.7-8.6
FSH 52.5 mIU/mL (high), 1.5-12.4

PSA, Serum 0.5 ng/mL (normal), 0-4
Cortisol AM 11 ug/dL (normal), 6.2-19.4
Estradiol, Sensitive 11 pg/mL (low, but in range), 3-70
IGF-1 208 ng/mL (normal), 116-358
TSH 1.3 uIU/mL (normal), 0.45-4.5

WBC 3.7 x10E3/uL (low), 4-10.5
RBC 5.08 x10E6/uL (normal), 4.1-5.6
Hematocrit 47.6 % (normal), 36-50

Seeing a new doc on Wednesday…

definitely look into that pituitary MRI…though almost unnecessary at this point as it will certainly come back positive, IMO…either that, or you have testicular cancer.

Starting to suspect a gonadotropin adenoma that produces no distinct hypersecretory syndromes other than high LH/FSH. I might be able to live with this without surgery, but I’d be curious to see its size (if I do have one), and whether it’s affecting other neural structures. I highly doubt that I have cancer as nuts were checked by two different doctors recently, and no telltale symptoms of testicular or abdominal pain. Granted, it might be harder to detect when testicles are very small! Sorry if this posted twice, having some computer difficulty.

MRI came back and showed no pituitary abnormality. So the high LH/FSH is still unexplained. They did find that my carotid arteries are slightly asymmetrical, and now suggest I test for anuerysm, but that is more in light of symptoms of blurred vision, not related to high LH/FSH.

When you apply the androgel do you exfoliate your skin to help with absorption? I tried androgel in the past it it only brought my levels up to 300 ng/dl (350-1000 range) using 5 pumps a day.

My endo recently said I should use androgel 1.62% to see if that works any better and will help keep my levels more consistent compared to test-cyp shots. I am still reluctant to use it since I have 2 small kids and dont want to risk exposure. Its hard to keep small kids off of you.

No, I do not exfoliate. I wasn’t aware people did that. Sounds a little hardcore like the guy in the movie, Gattaca.

I apply the gel mostly to my arms (biceps), chest, and shoulders. I was told to apply it in areas with lower body fat to reduce the aromatization of test into estrogen. I have virtually no body fat in those areas, so this might help with absorption. I’m not entirely sure why I respond so well at a low dose, but I suspect there is genetic variation amongst individuals.

Regarding your fear, I understand that. I would stick with your current protocol unless you’re experiencing negative sides from the less consistent levels. I hear you can also inject some forms of test (prop) several times per week, although I’m not aware of docs that regularly prescribe that protocol… nor would I want to inject that often.